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421: A Healthy Way to Look at Numbers in Hygiene - Christina Byrne
Episode 42118th May 2022 • The Best Practices Show with Kirk Behrendt • ACT Dental
00:00:00 00:40:51

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A Healthy Way to Look at Numbers in Hygiene

Episode #421 with Christina Byrne

Do you want to provide high-quality care for your patients? Then you need to track some numbers! And to share the most important metrics you should be tracking in hygiene, Kirk Behrendt brings back Christina Byrne, director of operations at ACT Dental. Kirk and Christina explain why you should care about those metrics and how to have the numbers conversation — because what gets measured gets improved! To learn more about the metrics that matter, listen to Episode 421 of The Best Practices Show!

Main Takeaways:

Tracking metrics will lead to a healthier team culture.

Knowing your numbers will improve your patients’ health.

Numbers will measure the value you provide to patients.

Metrics will measure the hygienists’ value to the practice.


“[Metrics in hygiene] are important for a couple of reasons . . . I think it’s important for hygienists to be responsible clinicians, providers. They support the profitability of the practice. And that's all secondary. The first and foremost reason to do this is because knowing what our numbers are and improving our numbers is only going to improve the health of our patient base. The key to the success of a healthy hygiene department or a healthy practice is how healthy are our patients. And we can't say, ‘Oh, yeah. Our patients are all healthy. We’re doing a great job. They're coming in every six months.’ If you don't track that information, you really don't know. You're just going by a feeling. And feelings, that's not telling you the true story.” (1:52—2:47)

“I think the key thing to start with, as a dentist, is to meet with your hygiene team and talk about your philosophy of care. Talk about what's important. Talk about, ‘What do we believe about periodontal disease? What do we believe about the health of our patients?’ Even, ‘What do we believe about when to take radiographs? Should we do a caries risk assessment? What are our thoughts on fluoride, on all of these things?’ When you can position that “why” of why we think this is important and how does it benefit our patients, then you can say, ‘Okay, great. We all align, and we all agree that fluoride is an important protocol or an important medicament that we can use for our patients. How are we going to track that we’re doing that?’” (3:04—3:55)

“What gets measured improves. But what gets measured and reported on improves exponentially. And I can say that in all of my experience working with teams that that is absolutely the case, that if we just skate by and we never, ever track numbers, then they're not going to improve. They're just not.” (7:11—7:30)

“I have a lot of offices that I work with, and the team member will say, ‘I never get a thank you. I never get recognized for what I do.’ Well, here is the perfect opportunity to get recognized for what you do. If you are reporting on your numbers every week and they're increasing, then that's great. Now, that's your recognition, if that's what your goal is. The other piece of it too, and I tell team members this all the time, you are going to measure your value, if you will, to the practice based on these numbers.” (8:17—8:50)

“You have two responsibilities as a team member: you have to align with the core values, and you have to get results. And so, if I'm not tracking results, then how can I then sit down in a meeting with my boss and ask for a raise or ask for some increase to my compensation? So, if I'm a hygienist and I can present to my doctor, ‘Hey, in the last six months, this is what I've done. I increased this. I increased that. I've converted a lot of patients to comprehensive exam. I had conversations about restorative dentistry, and then they scheduled,’ that gives you some power as the team member to come to that meeting with the data, not just a feeling or, ‘Hey, I've been here for two years. I should get a raise.’ Like, no. You are a provider in the practice. You have a responsibility to the profitability of the practice. And this is a golden opportunity for you.” (08:53—09:51)

“[Tracking] is a good way to take some of the emotion out of that conversation too. If the number is not there, now I'm going to say, ‘Okay, my perio percentage was down, but Sally’s was up.’ So, I'm going to go to Sally and say, ‘Tell me what you're saying. How are you having these conversations with the patients? What type of verbal skills are you using? Because I would love to make my patients as healthy as you're making your patients.’ And really, in the end, that's all that matters, is how healthy is our patient base. But we can't just say, ‘Oh, I think it’s okay.’” (11:00—11:37)

“It is all about progress. We talk about how the industry standard for what a healthy perio percentage is in a hygiene department would be somewhere around 30% to 35%. And our practice is — we have very few who are even at that level. But if you start tracking, and let's say you start tracking and you come up with 3%. Okay, great. At least, now, we know where we are. There's no judgment. We’re not going to be mad about it. We’re not going to be upset about it. We just know this is where our starting point is. So, for the next quarter, let's strive to get it to 7% by the end of the quarter, or even 5% by the end of the quarter.” (12:07—12:51)

“I always want to look at your perio percentage. That's key, is of the number of patients I treated in any given week, month, whatever you want to use, how many of those visits had a D4000 code attached to it? So, if I saw 178 patients and three of them were diagnosed with perio, that's a low number. I will grant it . . . And the CDC report was that 47.2% of adults over 30 have some form of perio disease — 47.2%. And 70% of adults over 65 have some sort of perio disease.” (14:05—14:58)

“I have offices that will say, ‘But our patient base is really healthy. They're fully maintained. We’re doing a great job.’ Okay. So, then my next metric is to look at new patients. How many new patients have you had? Your existing patient base might be healthy as can be. But what is your new patient number? Because that is a good opportunity for you to talk about perio and about a healthy smile.” (15:04—15:32)

“[The new patient metric is important] because, number one, we don't know what kind of care they’ve gotten in the past. And yes, I will admit that a lot of our offices are doing really great perio. They're doing really great maintenance on their patients, and their patients are probably very well-maintained. So, these new patients are a great opportunity for you to have that conversation and talk about it.” (15:44—16:06)

“I look at the perio percentage. A lot of times, I will start with that number. And sometimes, it’s good. Sometimes, I'm looking at a practice and it’s somewhere in the 17% to 20%. So, I would falsely think, ‘Oh, great. They're doing a lot of perio in that office. That's a good thing.’ Then, I will look at their perio diagnostic percentage and look at how many patients who have been in their chair actually got diagnosed with some new perio.” (16:22—16:54)

“I was guilty of it myself where I would have a patient in my chair who I had been seeing for years, and he would be coming in, and maybe he had a little bit more bleeding each time, but I was like, ‘Oh, it’s okay. That's just Joe. Joe always bleeds.’ And then, I thought to myself, ‘I am really doing a disservice to Joe to not actually talk to him about the progression of his disease.’ If every year, every six months, I'm charting and his fours are going to fives, and fives are going to sixes, yet I'm still keeping him on that perio maintenance gerbil wheel, then that's not really helping him.” (18:18—19:00)

“The numbers actually tell us how good we’re doing in that role and what we need to do, what kind of countermeasure we need to take. So, if I write a periodontal protocol and I start tracking our perio, and the numbers are not increasing, then I have to go back to that protocol and say, ‘What can we do differently here? Obviously, there's something in the protocol that is either not being followed, or maybe we need to make some updates to it.’ So, if we take that number off the person and put it on the system, it also removes that emotion as well.” (23:37—24:14)

“I think [the overall production of the hygienist is] really important to track. Because going back to the idea that as a hygienist you're a responsible member of the clinical team and a provider in the practice, it is tied to how you're compensated — or it should be, anyway. So, as a hygienist, what we've seen in the past is that you should be producing three times what your total compensation is. So, yeah, it is important to track the production. You should be about 30%, 33% of your production is your total compensation. So, if I'm a hygienist — and doctors are going to get mad at me for this — but if I'm a hygienist and I'm tracking that number, and it’s routinely like 25%, then I think I'd have a conversation with my doctor about how much I'm producing and how much I'm earning.” (27:04—28:07)

“Fluoride percentage is a good [metric] to track because that is a good benefit to a lot of patients. The perio accepted number — so, this is one where we can celebrate, because oftentimes, what happens is I'll see perio acceptance is at 100% — 100%, 100%, 100%. Except that I saw 300 patients and I talked to three about perio, and all three of them said yes — which is great. So, that's something to celebrate. So, we already have those verbal skills. But I would look at that number and say, ‘Maybe we’re not talking to all the patients. We’re only talking to the ones who we know are going to say yes.’ And I would turn that also around on the doctor too. So, when you track restorative acceptance, don't just look at 95% or 100% for restorative. Look at the dollar amount that you're proposing as well to the patient, because that tells another story. That's one of those metrics that it’s not just one number. You have to look at two for that one.” (30:22—31:20)

“Just because somebody says no today doesn't mean that they're going to say no in six months. And you have to think about each hygiene visit as a connected level of therapy or care that you're providing. It’s not one visit in six months, and another one in six months. Tie all those visits together and let the patient know that there is value in that. And make sure that there are common themes when you're having those visits. We talk about putting a reason for return. That's really powerful. It’s one extra line in your clinical notes, but it’s really powerful when the patient sits there, and they hear that you're still concerned about something that you talked about six months ago.” (33:52—34:39)

“I think it’s important to set goals and to imagine what you want your production-per-visit to increase. And I would say look back at history too, and if your hygiene production-per-visit is only increasing by the same percentage that you're raising fees, that's not good. Because we can look at that and say, ‘Oh, but it is increasing,’ ‘Yeah, and so are our fees. So, that's where that comes from.’ So, there are some things that people can try to trick me. But you can't trick me.” (35:34—36:05)

“Don't tie yourself to your patient’s response. So, even as a hygienist, if a patient says no, that's not on you. If you talk to them, and you guys all calibrate, and you decide what verbal skills you're going to use, you're not going to get every patient. Try really hard to not wear that patient’s disease around with you all day long, because it’s not on you. Our responsibility as providers and clinicians is to let the patient know what we see and give them every opportunity to make an informed decision. And so, they still might say no. And that's okay. We can't really wear that on our shoulders. It’s too hard. It’s not on us.” (36:53—37:38)


0:00 Introduction.

1:30 Why metrics in hygiene is so important.

2:48 Establish the important things with your team.

4:14 Your team can't read your mind.

5:13 How to start the tracking process.

7:48 Tracking is a golden opportunity.

11:43 It’s about progress.

13:54 Christina’s favorite metrics in hygiene.

15:37 Why the new patient metric is important.

16:55 How to measure your new perio percentage.

19:00 What is a good perio diagnosis number?  

22:46 Money spent on dentistry is one of the best investments.

24:14 Why having countermeasures is important.

26:27 Why it’s important to track your hygienists’ overall production.

28:10 Ways for hygienists to increase production.

30:10 Other important metrics to look at in hygiene.

31:20 Sometimes, you have to fire your patients.

35:27 Set production-per-visit goals.

36:40 Last thoughts on hygiene numbers.

Reach Out to Christina:

Christina’s email: 

Christina’s social media: @actdental

Christina Byrne Bio:

Christina Byrne has been involved in dentistry since 1985. Over the years, she has held many positions on the dental team, including dental assistant, business office, and dental hygienist. Christina’s extensive knowledge of the front office and clinical procedures is a great asset, and she loves to impart her knowledge to guide dental teams do the best they can to achieve a Better Practice, Better Life!

“One of the many unique things I love about ACT Dental is that we put as much emphasis on improving the culture of the practice as increasing the profitability. That is not to say we don’t have a keen sense of the financial health of the practice. But what we have learned time and time again is that when you do what’s right for yourself, your team, and your patients, the money will follow!” 



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